Social marketing techniques have enhanced the success of programs designed to improve the health outcomes of individuals or communities when adopting new health behaviors. Current research suggests, however, that behavior change models, when added to social marketing techniques, could result in even greater success in changing health behaviors and health outcomes. This retrospective analysis of the results of a Public Access Defibrillation (PAD) Trial, designed to improve a community's response to cardiac arrest, tests this proposition. Data from one of the 24 participating PAD Trial sites were analyzed and interpreted from a social marketing and behavior change model perspective, to assess the success in changing a community's response to cardiac arrest victims in 61 residential buildings that participated in the PAD Trial in New York City (NYC). The findings suggest that to improve the success of community-based, emergency response systems to cardiac arrest victims, health programs must first a...
The KinNET project came into existence because of the need to support a growing number of grandparents and other relatives providing care for children within the foster care system. It was a demonstration project funded by the Children's Bureau designed to create a national network of support groups for older relatives-mostly grandparents-caring for children in and associated with the foster care system. Grandparents and other relatives are an invaluable resource to the child welfare system. However, these caregivers are also an overburdened population that needs creative and supportive interventions to enhance their capacity to provide quality care and reduce the risks to the children. In this intervention the support group approach was tested (a replication of the Brookdale Foundation model with project management from Generations United). Support groups often provide kinship caregivers with access to important emotional and community support, information and referral, relaxation, and respite. This article briefly describes the project, a profile of the caregivers (n = 102) and the children in their care (n = 226), and highlights from the survey data. In addition, we discuss the three key lessons learned from the project and make recommendations to better serve this population. doi:10.1300/J045v22n03_14.
The most recent period of Massachusetts healthcare system reorganization began in the early 1980s. In part, this has been a response to soaring healthcare costs, countering them with diminished reimbursements. To decrease labor costs and survive in an increasingly competitive and market-driven healthcare environment, hospitals downsized and laid off nursing staff. Patient care and safety has concomitantly suffered. These efforts severely challenged nurses' status. Radicalized rank and file members of the Massachusetts Nurses Association mobilized against the association leadership's weak efforts to protect nurses' social and economic interests and the deteriorating quality of care. They transformed an association whose main focus was supporting nursing's professional image to one which became an activist labor union of professional workers. The history of this often contentious transformation is presented here within the context of these healthcare system changes. The MNA's successes and pending challenges within the Massachusetts healthcare system are also discussed.
Abstract Grandparents raising grandchildren experience caregiving stress, negatively influencing their mental health. They experience limited social supports and suffer from a lack of respite care and community resources. The present study attempts to explore needs of grandparent-headed families and factors related to grandparents’ depression. In 2015-19, surveys with 92 custodial grandparents were conducted in the northeastern U.S. The respondents were primarily white (77%) and 62 years old on average (ranged from 44 through 84) at the time of the interviews. The depressive symptoms ranged from 1 through 45, with the score of 16+ indicating clinical depression (41%). Sixty-three percent of grandparents reported a household income below $40,000 and 40% of them rated their health as poor or fair. Ninety-five percent reported at least one or more concerns in raising their grandchild (i.e., financial concerns, legal issues, and physical health). A multiple linear regression analysis was performed to examine the contributions of age, ethnicity, duration of care, factors related to multigenerational caregiving, social support from family members, social support from friends, and social support from significant others in accounting for grandparents’ depressive symptoms. The model explained 29% of variance in the outcome (R2=.290; adjusted R2=.231). Among the predictors, only one factor was significant: social support from family members (beta=-.352, p=.006). Grandparents with increased social support from family members have lower rates of depression. This finding reinforces the importance of familial support for grandparents raising grandchildren, and recommends the development of family-centered programs to offer support for custodial grandparents to promote caregivers’ well-being.
Attaining quality health care has long been a social policy priority for countries internationally. This discussion considers issues important to understanding quality, and audit implementation in particular. The paper covers, first, the principles and practice of audit and, second, broader implementation issues, which together point to the further development of quality initiatives in health in the United Kingdom health care context. To close, the future of audit as a means of improving health care is elaborated.
Previous analyses of the inverse relationship between a nursing home's Medicaid census and its quality of care have been based on samples limited to specific geographic regions, for-profit entities, or only skilled care facilities. The present study uses national-level data from the 1999 National Nursing Home Survey to examine the association between the proportion of beds designated for Medicaid residents and nurse staffing ratios. The results indicate that homes which designate a higher proportion of their beds for Medicaid recipients maintain lower ratios of registered nurses and nurse's aides to residents, even when key facility characteristics are controlled. It was also found that nursing homes with a higher proportion of Medicaid beds offer lower nursing ratios regardless of their profit status or the difference between private pay rates and Medicaid reimbursement rates. Since lower nursing ratios have been previously linked to negative outcomes, these findings suggest that homes which rely more heavily upon Medicaid recipients may be using cost-cutting strategies which have negative implications for quality.
As long-term care policy makers struggle with competing challenges including state budget deficits and pressures to expand homeand community-based services (HCBS), there is a pressing need for information on the comparative cost of Medicaid HCBS and institutional care. This paper uses the most recent available data (2002) to present three per participant expenditure comparisons between Medicaid HCBS waivers (which require that participants have an institutional level of care need) and institutional care: (1) program expenditure (waivers vs. the comparable level of institutional provision); (2) total Medicaid expenditure (program plus other Medicaid expenditure); and (3) estimated total public expenditure (Medicaid expenditures plus state and federal supplemental- income payments). This analysis estimates that when compared with Medicaid institutional care in 2002, HCBS waivers produced a national average public expenditure saving of $43,947 per participant. doi:10.1300/J045v22n02_03.
Summary Today, kinship care is equal part family tradition and social welfare policy. This volume explores the balance of the two and presents current practice challenges of formal and informal kinship care. It also addresses the seminal role of grandparents as kinship care providers.
The impact that parenting responsibilities have on the psychological well-being of African American grandparents raising grandchildren is an increasing concern in American society. Contemporary research studies indicate that African American grandparents who encounter a variety of challenges in raising their grandchildren are able to cope successfully with these situations if they derive a sufficient amount of psychological rewards from raising grandchildren (Giarrusso, Silverstein, & DuFeng, 2000). These rewards include increased gratification, feelings of usefulness, and increasing pride in their own abilities to meet new challenges (Fuller-Thomason & Minkler, 2000). This article will investigate how the coping resource factors of intergenerational solidarity, informal social support and spirituality enhance the psychological well-being of African American grandparents who are raising their grandchildren. doi:10.1300/J045v22n03_09.
Nationwide, grandparents raising grandchildren is a growing phenomenon. In the District of Columbia, 19% of children under age 18 live in kincare-headed households. This compares to 8% nationally. This article reports on findings from an AARP focus group study of 40 grandparents raising grandchildren in the District of Columbia. It tells the stories of individuals who have traveled different pathways to arrive at their common destiny of being a grandparent caregiver. It primarily uses the voices of African American grandmothers and grandfathers to address the resources and challenges they face as they care for and care about their grandchildren. Through hearing their stories, AARP crafted nine recommendations aimed at improving the quality of life of District of Columbia grandparents raising grandchildren. The article reports on recommendations emerging from the research and reinforces the need for collaboration among various stakeholders to address the fragmented service delivery system. doi:10.1300/J045v22n03_13.
Kinship caregivers view spirituality and religion as integral and holistic in nature and an essential coping component to their survival as caregivers. This article examines the following eight spirituality and religious themes defined by a group of African American caregivers of children: spirituality and destiny; spirituality and drugs; faith and healing; spirituality and negotiation; surviving through faith; spirituality, religion, and community; religion; worship and the child; and the need for respite through worshiping and self-care. Historical and social aspects regarding the role of spirituality and religion within the African American community are discussed. Qualitative data from a focus group of 19 low income African American kinship caregivers aged 40-70 years are used to present spiritual and religious clinical tools, techniques, and concepts for intervening with kinship caregivers. doi:10.1300/J045v22n03_07.
The purpose of this article is to offer a brief and concise history of relevant public welfare policies for a discussion of the effects of public welfare reform, and how it impacts families in ways not comprehensively understood. Social scientists' concerns about the potential for the families to be thrust into an "extreme poverty" status due to the forced workforce participation requirement and expiration of time limited benefits is discussed. A second concern regarding a "one size fits all" approach to work requirements for TANF recipients being unrealistic and insensitive is also discussed. The authors recommend a comprehensive multi-system analysis to determine the impact of welfare reform. There is also a recommendation that the workforce requirements should correlate to an assessment score based on the ability of welfare recipients to function in identified areas. Implications of maintaining a welfare reform policy status quo are identified.
Summary Orientation to the future, in the social science literature, is linked to social adaption and adjustment. This study examines the future outlook in African American kinship care families. The focus of the study was restricted to adolescents in the kinship care population and examined both youth's and parent figure's outlook for the future. Using the National Longitudinal Survey of Youth (NLSY97), the study describes the future orientation of African American youth who live with relative caregivers. It tests for differences in orientation to the future between kinship care parents and those with biological and other family types and tests the hypothesis of there being a significant difference in future orientation between youth and their relative acting as parent caregiver. Findings demonstrate significant variability in the future outlook of African American youth within kinship care families. The findings suggest that social workers and mental health practitioners who work with youth in goal setting behaviors should include the relative caregiver and the family in the counseling process.
This paper focuses on how potential race related salary inequity and racial discrimination patterns can be measured in health care organizations. Incorporating ethical principals to the measurement strategy helps conceptualize potential patterns of salary inequity. Convergent validity assessment through triangulation method allows for the measurement of parallelism, correspondence, and the affirmation of major findings. The most important benefit of the suggested strategies is the ability to assess and identify how discrimination may be occurring in organizations.
The Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) allows states considerable discretion in developing and implementing their Temporary Assistance for Needy Families (TANF) programs. Little research so far has compared the implementation of TANF programs across racial groups. Without such analysis, it is difficult to interpret program outcomes. Using client survey data from a large Manpower Demonstration Research Corporation (MDRC) study, the Project on Devolution and Urban Change, this article compares African-American, Hispanic and White Clients' experiences with diversion, case management, sanctioning, exiting welfare, and dispute resolution. Using residual differences analysis, this article identifies significant differences in treatment among racial and ethnic groups.
This article examines the processes by which the Anabolic Steroid Control Act of 2004, an act that added steroid precursors such as androstenedione to the list of Schedule III Controlled Substances in the United States, came to pass in both the House of Representatives and the Senate. Grounded theoretically in political economy, the article addresses, in the abstract, how the interplay of political pressures and economic influences stands to affect the actions of public officials, and how "tougher" drug policies-those touted to be more substantive and efficacious than existing regulations-often fail to effect change. The article concludes with implications for those involved in the regulation of anabolic steroids and steroid precursors.
Abstract Although research suggests numerous interventions that can improve immunization coverage (Taskforce on Community Preventive Services, 2000), there is often a gap between policies supported by scientific evidence and those implemented on a broad level by private and public entities. The question for this study is whether the variation in childhood (19 to 35 months) immunization coverage rates across states is related to significant variations in state regulatory regimes that may optimize the benefits of state registries and systems that are designed to improve assessment of immunization practices. Utilizing 2002 data from the CDC and survey data collected from state immunization program officials, we find that financial support for state immunization programs, opt-out state registries, and state-mandated participation in provider quality improvement and assessment programs have positive associations with statewide coverage rates. We also suggest that more active state governmental support for interventions supported by rigorous scientific evaluation will not only improve early childhood immunization coverage, but may also support other public health objectives such as life-time full immunization and improve bioterrorism response planning.
The KinNET project came into existence because of the need to support a growing number of grandparents and other relatives providing care for children within the foster care system. It was a demonstration project funded by the Children's Bureau designed to create a national network of support groups for older relatives-mostly grandparents-caring for children in and associated with the foster care system. Grandparents and other relatives are an invaluable resource to the child welfare system. However, these caregivers are also an overburdened population that needs creative and supportive interventions to enhance their capacity to provide quality care and reduce the risks to the children. In this intervention the support group approach was tested (a replication of the Brookdale Foundation model with project management from Generations United). Support groups often provide kinship caregivers with access to important emotional and community support, information and referral, relaxation, and respite. This article briefly describes the project, a profile of the caregivers (n = 102) and the children in their care (n = 226), and highlights from the survey data. In addition, we discuss the three key lessons learned from the project and make recommendations to better serve this population. doi:10.1300/J045v22n03_14.
As technological advances in the United States continue to improve the effectiveness of medical interventions, expectations among Americans of both improved health and extended life expectancy have also increased. At the same time, many of the population continue to lack the insurance necessary to access even the most basic healthcare services (Institute of Medicine, 2004; Tunzi, 2004; Saha & Bindman, 2001). With approximately 18,000 avoidable deaths attributed annually to inadequate medical coverage and 43.6 million individuals currently without insurance benefits, the need to address the disparity in access to treatment and a means of social justice in the distribution of health care is all too clear (Crispen & Whalen, 2004). As a nation relying on market mechanisms to regulate the costs and quality of available health resources (Baldor, 2003; Saha&Bindman, 2001), the welfare of society as a whole may soon be threatened by the provision of marginal services to a select minority as increasing numbers of the uninsured continue to experience less favorable clinical outcomes and higher mortality rates (Tunzi, 2004; Litaker & Cebul, 2003; Jackson, 2001; Sox, Burstin, Edwards, O'Neil et al., 1998). The author will first examine the consequences of being among the growing number of uninsured individuals in the United States. Attention will then be given to exploring the social justice issues inherent in this critical problem and evaluating these issues through the perspective of both libertarian and feminist theory. Using these theories, innovative strategies for attaining distributive justice in the provision of health care will be offered with recommendations for utilizing these alternative approaches to develop and implement future health policy.
